A case of ovarian hyperstimulation syndrome with spontaneous hemoperitoneum

We report a case of complicated severe OHSS that developed spontaneous hemoperitoneum. This was a potentially fatal complication of pharmacological stimulation of ovary in assisted reproduction. Here the life was saved, oophorectomy was prevented and fertility preserved by timely diagnosis and conservative surgery

Asymmetric radiation-induced toroidal flow and improved confinement in tokamaks

The role of impurity radiation in influencing the toroidal flow and radial electric fields (parameters critical for determining turbulent transport) has been studied on the edge of a tokamak plasma. It is demonstrated for the first time that the impurities distributed in an asymmetric (poloidally) manner may lead to significant density and temperature perturbations on magnetic surfaces. These, in turn, interact with the θ dependent toroidal field variations and yield a mean divergence of the stress tensor driving strong neoclassical toroidal flows. A self-consistent theory of interplay of equilibrium, fluctuations, neoclassical flows, and E→×B→ shear rotation in a tokamak is also presented. It is shown that the resulting enhanced toroidal velocity shear on the outer radiative layers produces a stabilizing effect on the well known instabilities (which determine edge transport) such as the drift resistive ballooning mode, the drift trapped electron mode, and the ion temperature gradient mode. For various values of the radiation asymmetry parameter, investigation of the turbulent particle flux as a function of the density gradient shows that the plasma can undergo a bifurcation into a better-confined state with a peaked density

Deteriorating Women's Health Due to Rising Exposure to Per and Polyfluoroalkyl Substances (PFAS): A Review

A major class of water pollutants emerging as a threat to human health, particularly women's health, is Per-and-poly-fluoroalkyl substances (PFAS). PFAS belongs to a group of fluorine-containing frequently used synthetic chemicals in consumers and products manufactured by industries. The major concern linked to PFAS is that they exhibit bioaccumulation potential as their perfluorocarbon moieties do not degrade or degrade extremely slowly when exposed to natural elements. The reason PFAS has been termed "forever chemicals." These chemicals are disposed of in aquatic bodies via improper disposal methods, PFAS also build or concentrate in the aquatic environment because they are persistent. These chemicals further enter the human food chain via drinking water. Consumption of PFAS by women leads to catastrophic health effects such as disruption of reproductive functions, development of fetal irregularities in pregnancy, alteration of hormone secretions, menstrual cyclicity irregularities, etc. They have even been linked to life-threatening diseases, such as the development of cancer in women. In this study, we have reviewed the existing research works available to understand the alarming consequences of PFAS on female health and the various challenges being faced due to inadequate treatment and management of these chemicals. Further, the scope of developing mathematical models for studying the extent of the harmful effects of PFAS on women's health as well as devising proper management and disposal practices, is discussed in this paper

A service evaluation of FIT and anaemia for risk stratification in the two week wait pathway for colorectal cancer

Introduction: New national guidance on urgent referral for investigation for Colorectal Cancer (CRC) included faecal occult blood testing in 2015. We evaluated faecal immunochemical testing (FIT) and anaemia as risk stratification tools in symptomatic patients suspected of having CRC.Methods: Postal FIT was incorporated into the CRC two week wait (2WW) pathway for all patients without rectal bleeding in 2016. Patients were investigated in the 2WW pathway as normal and outcomes of investigations were prospectively recorded. Anaemia was defined as haemoglobin less than 120g/L in women and less than 130g/L in men.Results: FIT kits were sent to 1106 patients with an 80.9% return rate; 810 patients completed investigation with 40 CRCs diagnosed (4.9%). Median FIT results were significantly higher in patients who were anaemic (median 4.8 iqr 0.8-34.1 versus 1.2 iqr 0-6.4, Mann-Whitney p less than 0.001).Some 538 (60.4%) had a result of less than 4 µgHb/gFaeces (limit of detectability) and 621 (69.7%) a result less than 10 µgHb/gFaeces. Sixty per cent of CRCs had a FIT reading of >150 µgHb/gFaeces. Five CRCs diagnosed in patients with a FIT4 µgHb/gFaeces had 97.5% sensitivity and 64.5% specificity for CRC diagnosis. A FIT result of >4 µgHb/gFaeces and/or anaemia had a 100% sensitivity and 45.3% specificity for CRC diagnosis.Conclusion: FIT is most useful at the extremes of detectability; strongly positive readings predict high rates of CRC and other significant pathology, whilst very low readings in the absence of anaemia or palpable rectal mass identify a group with very low risk. High return rates for FIT within this 2WW pathway indicate its acceptability

Recombinant fusion protein identified by lepromatous sera mimics native Mycobacterium leprae in T-cell responses across the leprosy spectrum

Pooled polyvalent sera from lepromatous leprosy patients were used to screen a lambda gt11 recombinant DNA expression library of Mycobacterium leprae in order to identify the relevant antigens recognized by the human immune response. Of the 300,000 phages screened, 4 clones were identified that coded for fusion proteins of the same molecular mass. The fusion protein from clone LSR2 was tested for immunoreactivity in assays using peripheral blood cells and sera from 11 laboratory personnel and 105 patients across the leprosy spectrum. LSR2 protein appears to be predominantly a T-cell antigen. It evokes similar lymphoproliferative responses as the native bacillus both at the individual level and in the leprosy spectrum as a whole. Though only 50% of patient sera with anti-M. leprae antibodies reacted with the fusion protein, the pattern of reactivity in the antibody responses was also similar for the various clinical types. The coding regions of clones LSR1 and LSR2 are identical. They show no homology with sequences stored in data banks and encode a protein of 89 amino acids with a calculated molecular mass of approximately 10 kDa

Cardiac arrest due to lymphocytic colitis: a case report

<p>Abstract</p> <p>Introduction</p> <p>We present a case of cardiac arrest due to hypokalemia caused by lymphocytic colitis.</p> <p>Case presentation</p> <p>A 69-year-old Caucasian man presented four months prior to a cardiac arrest with watery diarrhea and was diagnosed with lymphocytic colitis. Our patient experienced a witnessed cardiac arrest at his general practitioner's surgery. Two physicians and the emergency medical services resuscitated our patient for one hour and four minutes before arriving at our university hospital. Our patient was defibrillated 16 times due to the recurrence of ventricular tachyarrhythmias. An arterial blood sample revealed a potassium level of 2.0 mmol/L (reference range: 3.5 to 4.6 mmol/L) and pH 6.86 (reference range: pH 7.37 to 7.45). As the potassium level was corrected, the propensity for ventricular tachyarrhythmias ceased. Our patient recovered from his cardiac arrest without any neurological deficit. Further tests and examinations revealed no other reason for the cardiac arrest.</p> <p>Conclusion</p> <p>Diarrhea can cause life-threatening situations due to the excretion of potassium, ultimately causing cardiac arrest due to hypokalemia. Physicians treating patients with severe diarrhea should consider monitoring their electrolyte levels.</p

"In the interests of justice?" The International Criminal Court, peace talks and the failed quest for war crimes accountability in northern Uganda

This article analyzes the first peace talks to take place against the backdrop of an International Criminal Court (ICC) investigation: the Juba Talks between the Lord’s Resistance Army and the Government of Uganda (2006–2008). Drawing on field research and original source material, it departs from well-worn peace versus justice debates and provides new empirical material to explore how the presence of the court shaped domestic political dynamics at Juba. It argues that at the level of broad rhetoric, the presence of the court created significant discord between negotiating parties. On a practical level, however, it created space for consensus, but not the type envisaged by international justice promoters. The court came to be seen by both sides as an intervention that needed to be contained and controlled. This resulted in the politically expedient Agreement on Accountability and Reconciliation, which showcased a transitional justice “tool-kit,” but was based on a shared desire to evade the jurisdiction of international criminal justice. Given its practical complexity, the transitional justice agreement was ultimately rejected by Joseph Kony, who became increasingly distrustful of his own negotiating team at Juba. In findings relevant to other contexts, the article presents in-depth analyses of how domestic political dynamics around the ICC intervention produced a national transitional justice framework designed to protect both parties from war crimes accountability

Accounting for the competing risk of death to predict kidney failure in adults with stage 4 chronic kidney disease

IMPORTANCE Kidney failure risk prediction has implications for disease management, including advance care planning in adults with severe (ie, estimated glomerular filtration rate [eGFR] category 4, [G4]) chronic kidney disease (G4-CKD). Existing prediction tools do not account for the competing risk of death.OBJECTIVE To compare predictions of kidney failure (defined as estimated glomerular filtration rate [eGFR] <10 mL/min/1.73 m(2) or initiation of kidney replacement therapy) from models that do and do not account for the competing risk of death in adults with G4-CKD.DESIGN, SETTING, AND PARTICIPANTS This prognostic study linked population-based laboratory and administrative data (2002-2017) from 2 Canadian provinces (Alberta and Manitoba) to compare 3 kidney risk models: the standard Cox regression, cause-specific Cox regression, and Fine-Gray subdistribution hazard model. Participants were adults with incident G4-CKD (eGFR 15-29 mL/min/1.73 m(2)). Data analysis occurred between July and December 2020.MAIN OUTCOMES AND MEASURES The performance of kidney risk models at prespecified times and across categories of baseline characteristics, using calibration, reclassification, and discrimination (for competing risks). Predictive characteristics were age, sex, albuminuria, eGFR, diabetes, and cardiovascular disease.RESULTS The development and validation cohorts included 14 619 (7070 [48.4%] men; mean [SD] age, 74.1 [12.8] years) and 2295 (1152 [50.2] men; mean [SD] age, 71.9 [14.0] years) adults, respectively. The 3 models had comparable calibration up to 2 years from entry. Beyond 2 years, the standard Cox regression overestimated the risk of kidney failure. At 4 years, for example, risks predicted from standard Cox were 40% for people whose observed risks were less than 30%. At 2 years (risk cutoffs 10%-20%) and 5 years (risk cutoffs 15%-30%), 788 (5.4%) and 2162 (14.8%) people in the development cohort were correctly reclassified into lower- or higher-risk categories by the Fine-Gray model and incorrectly reclassified by standard Cox regression (the opposite was observed in 272 patients [1.9%] and 0 patients, respectively). In the validation cohort, 115 (5.0%) individuals and 389 (16.9%) individuals at 2 and 5 years, respectively, were correctly reclassified into lower- or higher-risk categories by the Fine-Gray model and incorrectly reclassified by the standard Cox regression; the opposite was observed in 98 (4.3%) individuals and 0 individuals, respectively. Differences in discrimination emerged at 4 to 5 years in the development cohort and at 1 to 2 years in the validation cohort (0.85 vs 0.86 and 0.78 vs 0.8, respectively). Performance differences were minimal during the entire follow-up in people at lower risk of death (ie, aged <= 65 years or without cardiovascular disease or diabetes) and greater in those with a higher risk of death. At 5 years, for example, in people aged 65 years or older, predicted risks from standard Cox were 50% where observed risks were less than 30%. Similar miscalibration was observed at 5 years in people with albuminuria greater than 30 mg/mmol, diabetes, or cardiovascular disease.CONCLUSIONS AND RELEVANCE In this study, predictions about the risk of kidney failure were minimally affected by consideration of competing risks during the first 2 years after developing G4-CKD. However, traditional methods increasingly overestimated the risk of kidney failure with longer follow-up time, especially among older patients and those with more comorbidity.Development and application of statistical models for medical scientific researc

Money talks: moral economies of earning a living in neoliberal East Africa

Neoliberal restructuring has targeted not just the economy, but also polity, society and culture, in the name of creating capitalist market societies. The societal repercussions of neoliberal policy and reform in terms of moral economy remain understudied. This article seeks to address this gap by analysing moral economy characteristics and dynamics in neoliberalised communities, as perceived by traders in Uganda and sex workers in Kenya. The interview data reveal perceived drivers that contributed to a significant moral dominance of money, self-interest, short-termism, opportunism and pragmatism. Equally notable are a perceived (i) close interaction between political–economic and moral–economic dynamics, and (ii) significant impact of the political–economic structure on moral agency. Respondents primarily referred to material factors usually closely linked to neoliberal reform, as key drivers of local moral economies. We thus speak of a neoliberalisation of moral economies, itself part of the wider process of embedding and locking-in market society structures in the two countries. An improved political economy of moral economy can help keep track of this phenomenon